Reimbursement

TECENTRIQ Sample Coding

This coding information may assist you as you complete the payer
forms for TECENTRIQ. These tables are provided for informational
purposes only. Please visit CMS.gov or other payers’ websites to obtain
additional guidance on their processes related to billing and coding
for single-use vials and wastage.

Non-small Cell Lung Cancer (NSCLC)

TYPE

CODE

DESCRIPTION

Diagnosis: ICD-10-CM

C34.00–C34.02

Malignant neoplasm of
bronchus and lung; main bronchus

C34.10–C34.12

Malignant neoplasm of
bronchus and lung; upper lobe

C34.2

Malignant neoplasm of
bronchus and lung; middle lobe

C34.30–C34.32

Malignant neoplasm of
bronchus and lung; lower lobe

C34.80–C34.82

Malignant neoplasm of
bronchus and lung; overlapping sites

C34.90–C34.92

Malignant neoplasm
of bronchus and lung; unspecified part

Drug: HCPCS

J3590

Unclassified biologics

J3490

Unclassified drugs

J9999

Not otherwise classified,
antineoplastic drugs

Hospital Outpatient HCPCS

C9483

Injection, atezolizumab, 10mg

Drug: NDC Note: Payer requirements regarding
use of a 10-digit or 11-digit NDC may vary. Both formats are
listed here for your reference

10-digit

11-digit

50242-917-01

50242-0917-01

1200 mg/20 mL
single dose vial

Administration procedures: CPT

96413

Chemotherapy administration,
intravenous infusion technique; up to 1 hour, single or initial
substance/drug

These codes are not all-inclusive; appropriate codes can vary by
patient, setting of care and payer. Correct coding is the
responsibility of the provider submitting the claim for the item or
service. Please check with the payer to verify codes and special
billing requirements. Genentech does not make any representation or
guarantee concerning reimbursement or coverage for any service or item.

Many payers will not accept unspecified codes. If you use an
unspecified code, please check with your payer.

Appeals

If your patient’s health insurance plan has issued a denial, your
BioOncology Field Reimbursement Manager (BFRM) or Genentech
BioOncology® Access Solutions for TECENTRIQ Specialist can provide
resources as you prepare an appeal submission, as per your patient’s
plan requirements.

If a plan issues a denial:

The denial should be reviewed, along with the health insurance
plan’s guidelines to determine what to include in your patient’s
appeal submission.

Your BFRM or Genentech
BioOncology Access Solutions Specialist has local payer coverage
expertise and can help you determine specific requirements for your
patient.

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